[French Society of Anesthesia and Intensive Care. Arterial catheterization and invasive measurement of blood pressure in anesthesia and intensive care in adults].

A group of 13 experts appointed by the French Society of Anaesthesia and Intensive Care has produced the following guidelines for arterial catheterisation and invasive measurement of systemic arterial blood pressure in adults. Teflon or polyurethane catheters are recommended with a maximal size of 18 gauge for femoral and axillary arteries and 20 gauge for the others. For small arteries (radial and pedious arteries) a maximal length of 3-5 cm should be preferred. The benefit of heparin-coating is not documented. Incorporation of salts for radiopacity is useless and increases thrombogenicity. Use of a flush device with a constant flow of 2 mL.h-1 and a fast flush valve connected to normal saline under pressure is recommended. Manual intermittent flushing with a syringe is contra-indicated. Addition of heparin (2500 IU.500 mL-1 of flush solution) increases the duration of catheter patency and is recommended for catheterisations of more than 24 h duration. Ready for use devices are to be preferred. Distortion of pressure wave may be minimized by employing low volume, low compliance, low resistance devices. The number of connections should be as low as possible and all of Luer-lock type. The stopcocks should be clearly identified to minimize the risk of accidental intra-arterial injection. The device should be transparent for disclosure of bubbles, which lead to waveform distortion. For catheter placement the operator should follow the usual preparation as for any aseptic surgical procedure with cap, mask, gloves and sterile towel. The insertion site is prepped either with chlorhexidine or povidone-iodine. In the conscious patient, local anaesthesia by injection and/or topical application (EMLA) is recommended. Direct arterial puncture should be preferred rather than transfixion. Catheterisation of deep vessels is facilitated by Seldinger technique, which is recommended whatever the site of placement when long term monitoring and/or difficulties of insertion are foreseen. The radial artery is the site of choice for elective cases. The non-dominant hand should be preferred. Puncture must be preceded by assessment of adequacy of the collateral flow by the Alien test. The femoral artery is a valuable site for emergency situations. Before catheterisation, the artery should be auscultated for a murmur. Puncture of a vascular prosthesis is contra-indicated. The dressing should be changed every four days only. Sites of blood withdrawal should be manipulated with compresses soaked with chlorhexidine or povidone-iodine. The arterial catheter is only changed in case of evidence of local infection or ischaemia. The catheter removal should be considered as an aseptic surgical procedure. The catheter completeness has to be checked. A systematic culture of the catheter is not required.